Chemagination 2010 Entry Form

2010 CHEMAGINATION CONTEST

ENTRY SUBMISSION FORM

Notes:

Use this form if you are a TEACHER submitting a Chemagination Article for your students.
You must have the article as a document file (preferably Microsoft Word) on your computer before you fill out the form below.
You must submit one form for each student entry.
The deadline is midnight March 15^th.

Teacher's Name

Full Name

(required)

School

(required)

Street Address
(US Mail)

City, State Zip

Phone

(XXX-XX-XXXX, required)

E-mail address

(required)

Re-type E-mail address

(required)

Title of Presentation

(required)

Category

(required)

Document file

(.pdf or .doc required)

Figure(s)
(optional - we prefer to have figures and illustrations embedded in the document file)

1. (optional)
2.
3.
4.
5.
6.

Name of 1st Student Author
(required)

Grade:

Name of 2nd Student Author
(required)

Grade:

Name of 3rd Student Author
(optional)

Grade:

Any Short Message to the organizers

PLEASE... Review the above data for accuracy before submitting.